As anyone who has worked overtime to complete a project or stayed up through the night tending to a sick child can attest, lack of sleep affects just about everything – from well-being and personal relationships to job performance and alertness. And recent studies suggest that the repercussions of too little sleep aren’t only personal: According to the National Highway Traffic Safety Administration, drowsy drivers caused roughly 100,000 crashes on our nation’s highways in 1998. Likewise, accidents attributed to sleep-deprived workers cost the federal government and private businesses billions of dollars each year in workmen’s compensation.
Getting a good night’s sleep isn’t something to just dream about, though. As our commonsense tips show, a little planning and discipline are all that’s needed to get eight hours of restorative zzz’s.
Good Night, Sleepyhead
Make it a priority to get eight hours of sleep a night. Establish a fairly consistent sleep schedule and stick to it – that way you are tired and ready to sleep come bedtime.
Say no to coffee, tea, colas, and chocolate, all of which contain the stimulant caffeine, for at least four hours prior to turning in.
Avoid alcoholic beverages. A late-night toddy may make you drowsy, but it will ultimately compromise the quality of deep sleep. Dehydration, headaches, and frequent urination are common side effects that can contribute to a night of less-than-restful sleep.
Exercise early in the day. Working out before bedtime will energize your body, making it difficult to fall asleep.
Review current medications with your doctor or pharmacist to determine if insomnia is a side effect.
Take a bath or stretch to soothe tired muscles and relieve stress.
Keep a journal. Writing down your concerns and thoughts before retiring can help to reduce anxiety and put the problems of the day in perspective.
Turn off all lights and draw curtains or shades. If it is impossible to eliminate outside light, consider wearing a sleep mask.
Minimize noise. If your neighborhood is particularly noisy, invest in foam earplugs (available at drug stores) or a fan, the whir of which should drown out more persistent sounds.
Keep your bedroom cool. Between 60 [degrees] and 65 [degrees] F is considered ideal, according to the nonprofit Better Sleep Council.
Make sure your mattress is comfortable and offers adequate support for your body. If you frequently wake up experiencing aches and pains, it’s time to consider purchasing a new mattress (see “Mattress Matters,” above, for details).
Good luck and good night!
“Most of us need eight hours of sound sleep to function at our best, and good health demands good sleep,” says Thomas Roth, Ph.D., the director of the Sleep Disorders Research Center at Henry Ford Hospital, in Detroit, in Detroit. “People have no idea how important sleep is to their lives,” he adds. According to the National Sleep Foundation, a Washington, D.C.-based nonprofit, Americans on average sleep about seven hours a night. Nearly a third of us, however, sleep six hours or less during the workweek.
Getting the Rest You Need
At the sleep disorder clinic at Good Samaritan Medical Center, in West Palm Beach, Fla., codirector Dr. Allen Rosen recommends that patients experiencing insomnia make sure they keep to a regular sleep schedule and only hit the sack when truly tired. Patients at the clinic are cautioned to avoid eating, paying bills, listening to the radio, or watching TV in bed so that they will come to associate their beds with sleep. Dr. Rosen also encourages the individuals he treats to try deep-breathing exercises or listening to relaxation tapes (available at most bookstores) to unwind before turning in. Patients at the clinic who find sleep elusive are also told to turn their clocks so that the dial faces the wall. “There’s nothing worse than watching the clock ticking and worrying that you’re not getting enough sleep,” says Dr. Rosen.
Although we spend roughly a third of our lives in bed, few of us give our mattresses adequate attention. Jim Ruehlmann, of the mattress manufacturer Sealy, offers the following advice:
* Replace mattresses and box springs every seven to 10 years.
* Buy the best mattress you can afford and make certain that the coil count is at least 300.
* If you’re part of a couple, always shop for a new mattress together.
* To prolong the life of your bed and even out wear, use a mattress pad and rotate your mattress every few months (turn it upside down, then top to bottom).
* Keep your mattress clean by vacuuming it regularly
Snoring is such a problem for me that I recently decided to get in touch with Gary Zammit, Ph.D., director of the Sleep Disorders Institute at St. Luke’s-Roosevelt Hospital in Manhattan, who offered me an exam. Frankly, I wanted to know how to stop snoring.
Zammit examined my throat, took a medical history and asked me a long list of questions about both my snoring pattern and sleep habits. The questions were wide-ranging – from how much coffee I drank to whether I ever saw or heard things that weren’t there as I was falling asleep or waking up (hypnagogic hallucinations). He was looking for two things: clues as to why I snored and warning signs that might indicate a condition called sleep apnea, a serious medical problem of which snoring is only a symptom.
According to Zammit, my snoring-onset scenario is not unusual. For men, the age-related snoring stats read like this: An estimated 5 to 7 percent of boys snore. By our early 30s, the number doubles. The biggest snoring spike starts as we approach our 50s and moves upward until, by our early 60s, as many as half of us make some obnoxious noises in the night.
But why do these tissues in our throats – which haven’t peeped since day one – suddenly start rattling, waking up our domestic partners as we near 40? Three reasons:
* Extra pounds. From the time we’re teenagers, we tend to slowly put on weight. Fat cells in the mouth and neck then narrow our airways, and the narrower the passage, the more turbulence is created – as whitewater rafters know.
* Girlie-man muscles. Aging, and the concurrent loss of muscle tone, may start us sliding toward snoring, says Neil B. Kavey, M.D., the director of the Sleep Disorders Center at Columbia-Presbyterian Medical Center in New York. Past the age of 35,” he says, the muscles that line the airways are not quite as good as they once were at holding the airway open.” Again, the more narrow the airway, way, the more turbulent the influx of air.
* Bad vibrations. Not only do aging muscles hold the airway open less efficiently, but they also start vibrating, waking up the good woman who was kind enough to cuddle with you.
Beyond these three major factors, there are several other potential causes of nighttime noisiness, such as:
* A packed proboscis. If your nose is stuffed up – by either a cold or allergies – you may gulp air through your mouth, which speeds up airflow. Try elevating the head of your bed for a better breathing position.
* Tonsils or tumors. Yes, grown-ups can get tonsillitis, too. Sometimes that’s enough to precipitate snoring. The same is true of swollen adenoidal tissue. Any kind of asymptomatic growth – from a perfectly benign lesion to a potentially serious tumor – can be the source of snoring.
* Anatomical abnormalities. A deviated septum, in combination with the ravages of age, may set you snoring. “Sometimes people with short necks are prone to snoring,” says Dr. Kavey, “as are people with overbites and small jaws.”
* latrogenic interference. Cool word, huh? Pronounced eye-a-tro-GEN-ic, it means caused by a medical treatment, and is often used in malpractice suits. Some drugs, such as sedatives and certain antihistamines, can cause swelling of the membranes that line the throat. Ask your doctor if a medication could be the cause of your annoying nocturne.
* Cigarettes. If increased risk of heart attack, lung cancer, stroke and emphysema haven’t done the motivational trick for you when it comes to quitting, you probably won’t care, but how’s this? Caution: The surgeon general also thinks smoking can cause snoring. It irritates and narrows the throat lining and increases mucus buildup.
* A belt before bed. Alcohol’s a muscle relaxant, and those relaxed muscles may tremble in the turbulence.
* A bone-dry bedroom. If your bedroom is very dry, throat tissues can swell. In some cases, a humidifier may help.
Finding no obvious cause for my snoring, Zammit suggested I spend a night at his snoratorium to undergo polysomnography – a sleep study that would monitor pretty much everything my body did while I was unconscious.
A week later I checked in with Rena and Flex, the sleep technicians, who showed me to my room. The accommodations were surprisingly comfortable. This was no cold, clinical laboratory, but a carpeted, air-conditioned room, complete with a queen-size bed and even that rarest of commodities in medical facilities, up-to-date magazines.
Once I was in my sleepwear, Rena and Flex began peppering my body with sensors. Within 15 minutes, I had 17 different sensors attached from head to calf. There were several electrodes on my skull to measure brain activity. There were also sensors to measure eye movement, chest and stomach movement, leg movement and heart rate. There was a microphone to record snoring sounds, a device attached under my nose to measure airflow in and out, and another placed on my fingertip to take my pulse and record the level of oxygen in my blood. A sensor attached to my chin would detail chin movement and the level of muscle relaxation.
I wondered how I would be able to sleep at all with all this equipment attached to me. But once the technicians gathered all the wires behind my head in a sort of polysomnographic ponytail, it was surprisingly comfortable. I could move easily about the room.
When I felt ready to go to sleep, Flex plugged all the wires from the sensors into a central control panel, disappeared into the next room and then, through an intercom, asked me to do a few things that would establish baseline readings. She came back in and warned me that if some of the sensors came off in the middle of the night, someone might have to come in to reattach them. Then she wished me a sweet good night and returned to her post, from which she would monitor the equipment overnight as it spewed forth data about my every breath and brain wave.
The next morning, Flex’s lilting Caribbean voice gave me a wake-up call through the speaker over the bed. She came in, removed the wires and asked me a few follow-up questions. Then I shampooed the electrode paste out of my hair, got dressed and was on my way.
A few days later, Zammit told me that although I had had one apnea (shutting down of my airway) during the night and 75 hypopneas (partial closures), they didn’t compromise the amount of oxygen in my blood or the function of my heart.
As to my snoring, he suggested that I try to lose some weight (at 5 feet 11 inches tall, I should be 15 pounds lighter, with an ideal of about 175 pounds), and that I try some “positional treatments,” tricks that help you sleep on your stomach, where you’re less likely to snore. See Little Shop of Snorers,” page 90.] If those didn’t work, he recommended a dental appliance – either a tongue-retaining device or a jaw repositioner – as the next-best bet. He also suggested that I have another overnight sleep study in a year or two, to be sure that serious sleep apnea had not developed.
I’m happy to report that I’ve lost half the weight already. I have also sewn a golf-ball pouch into the back of a few of my T-shirts. The Titleist technique is no fun, but it’s amazing how quickly it makes you stop rolling over. According to Jody, my snoring is both a little less frequent and less loud.
In fact, she recently woke me up at dawn – this time, however, not with a cranky kick but with a needy caress. She had slept right through the night and apparently had energy to burn.
After our tender tango, my girl got up and about the business of the day. I, in the time-honored male tradition of afterglow, rolled over and went back to sleep.
Dr. Stanley Coren has written a book on sleep deprivation, Sleep Thieves, and says his research shows that “for each hour under eight hours of sleep, you lose one point in IQ. And for every hour below seven you can lose two points of IQ.” Anecdotal evidence supports this. Jennifer Coppens, a 19-year-old Calgary high school student who works 25 hours a week, testifies that “most days I wake up tired.” She claims she routinely nods off in math class, and recently flunked an exam.
Dr. Coren, 54, is becoming an master of neuropsychological esoterica. In 1992 he published The Left-Handed Syndrome, which posits that southpaws die seven years younger than right-handers. “Our mechanical world is built for right-handers,” he explains. “Left-handed people die earlier due to accidents.” He is now working on a book about the psychology of dog owners. “It’s an entertaining way to shed light on the human personality,” he says.
Sleep is a more serious topic. “People generally rise early and retire early, but a biochemical change occurs at puberty and can last all the way through the person’s university years,” says Dr. Coren, a father of two fully-grown offspring. “During that time, youths stay up late and have difficulty coping with morning activity. That’s why it takes two sticks of dynamite to get them out of bed.”
Lack of sleep affects some teenagers’ brainpower more than others. Those with IQs around 115 or more can survive several hours of deprivation a night. But a teenager with an IQ of 100 who tallies a similar nightly sleep deficit can lose up to 15 IQ points a week–and risk failing exams. Dr. Coren says the IQ deficit can be eliminated by sleeping soundly on weekends. Unfortunately, “Sleep is the last thing kids think about on Fridays and Saturdays,” he observes.
The deprivation can become so severe that “microsleep,” in which the brain enters a somnambulant state for 10 seconds to a minute, results. “That’s why we hear reports of students falling asleep in class. The phenomena is dangerous if you’re driving a car.” Some U.S. states have proposed shifting high school and university classes several hours to compensate. “But this was roundly pooh-poohed,” recalls Dr. Coren. “Critics complained it would lead to cots being installed in school hallways.”
Student Coppens’ plight notwithstanding die-hard party animals don’t see what the fuss is about. “I party all the time and never flunk exams,” boasts Brian Smith, 17, of Vancouver. “Me and my buddies even party on week-nights, and we’re no worse for wear.”
Bernie Peets, general manager of UBC’s Alma Mater Society, does not think there is much to worry about. The 49-year-old father of two remarks that “today’s youth take their studies far more seriously than my generation did. And if sleep really does affect IQ, it will only take a couple of flunked exams to shock kids into falling in line.”
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So here we show you how to nip each type of sleep-disturbance pattern in the bud with the best self-help techniques. (See ” Sleep-Disorders Clinics” on page 80 for help in determining when your sleep problem is serious enough to deserve a sleep-medicine specialist’s attention.)
PATTERN #1: TROUBLE FALLING ASLEEP
Release the pressure valve. It’s one thing to have trouble sleeping. It’s quite another to start worring about having trouble sleeping. Before long, the worry itself can start to interfere with your ability to fall asleep, even when the initial cause of sleeplessness is gone. Fortunately, there’s much you can do to eliminate this second tier of trouble.
One thing that adds to the pressure of falling asleep is seeing the bedroom clock–a reminder of how late it is. “The clock in the bedroom is poison in most cases,” says Dr. Hauri. “It puts too much pressure on you to fall asleep. You only struggle with yourself, trying harder and harder to sleep the later it gets.” He suggests that you set your alarm and stick it in a dresser drawer. Hide your watch, and throw a towel over the VCR clock, too.
Relaxation techniques (such as meditation, counting your breaths, slowly tensing and relaxing muscles, and others) can help. Find one you’re comfortable with and remember not to try too hard to relax, or you’ll just make yourself more tense. Dr. Hauri offers this counting method in his book No More Sleepless Nights (John Wiley & Sons, 1990):
With your eyes closed and while lying in bed, let your body go limp. Count slowly from 100 to 0, seeing the numbers being written one below the other, like they’re on descending stair steps. Feel your body relax. Keep counting until you fall asleep.
Control in-bed time. When time spent tossing and turning is added to sleep time, the in-bed period may begin to spread too far, and quality of sleep can be affected. “It’s like water spreading over a big area. The longer you stay in bed, the shallower your sleep will be,” says Dr. Hauri. “Most people stay in bed too long when they haven’t slept through the night. So they learn to associate the bedroom with tossing and turning, not sleeping.”
So retire to your bedroom only when you’re sleepy. Don’t make yourself go to bed at a certain time if you aren’t tired.
Some sleep experts say that you shouldn’t read, eat or watch TV in bed. If you’re having trouble falling asleep, they say, get up and go to another room until you’re sleepy again, no matter how many times a night this happens. the goal is to associate your bedroom with sleepiness (and pleasure), not frustration.
Watch your tolerance for you-know-what. It would be hard to find someone who didn’t know that caffeine can hinder your ability to fall asleep. But here’s something you might not realize: Your body’s tolerance of caffeine can be dramatically altered as you grow older.
Try reducing the caffeine in your diet for a few weeks. (Decrease it slowly, becayse some heavy caffeine users experience headaches, irritability and other withdrawal symptoms at first.) If you sleep better and are less anxious, caffeine could be the culprit in your insomnia. Dr. Hauri recommends that if you have insomnia you should consumer fewer than two eight-ounce cups of coffee a day, and never have caffeine after lunch.
One more thing to keep in mind: Even if caffeine isn’t keeping you from falling asleep, it can cause you to wake up more often during the night, and can make sleep less restful.
Sleep in synch. Many people who can’t fall asleep are suffering from delayed sleep phase syndrome (DSPS). Their circadian rhythm–a kind of internal clock–is out of synch with the world they live in.
They find themselves going to sleep at 3 a.m. and staying in bed until noon. They may get the normal length of sleep, but it comes at the wrong time. And when they have to get up early, they suffer sleep deprivation.
Fortunately, there is a solution: bright light. How bright is bright? “About four to five times brighter than ordinary indoor lighting,” says Al Lewy, M.D., Ph.D., director of the sleep and mood-disorders clinic at the University of Oregon Health Science Center.
Bright light helps to reset the body’s circadian rhythm, or internal clock, which has been found to control hormone levels, body temperature hormone levels, body temperature and arousal. “You use the bright light as soon as you wake up for 30 to 120 minutes per day. Then each day, or every other day, you move your wake-up time (and therefore your light-exposure time) to 15 minutes earlier, until you’re waking up at the desired time.
“This should automatically move your sleepiness time earlier so you fall asleep earlier,” says Dr. Lewy. Though success with this technique has been reported in a matter of days, he says. “It usually takes a few weeks. And you may need to use light exposure every other day or so, 15 to 60 minutes duration, to maintain the correct sleep phase. If you’re waking up early already, obviously you don’t need to shift your wake-up time progressively earlier. But you do need to get bright light as soon as you wake.”
You can purchase a light box, available through some drugstores and medical-supply houses. “They’re simply portable lights that use ordinary fluorescent bulbs, covered by a plastic diffuser,” says Dr. Lewy. The light should shine on your face from above at a 45-degree angle, while you look forward the light (but not into the light) once or twice a minute. It’s best to scan the light from side to side.
PATTERN #2: UNSOUND SLEEP
Increase body heat. Regular exercise has often been advised as a means of improving sleep. Now researchers have discovered a link between exercise and nightime body temperature. And it’s becoming clear that with exercise, how and when really matter.
The body’s temperature normally goes up during the day and down at night, sometimes by as much as 2[degrees]F. But insomniacs have less variation: They don’t get as warm in the day or as cool at night, and their sleep is shallow and fragmented. But if you heat up your body with a workout about six hours before bedtime, you’ll start cooling down just as you want to go to sleep. Be sure not to exercise sooner than three hours before going to bed, or the stimulant effect of the workout might keep you awake.
Aerobic exercise that gets your heart rate up is what you need–walking, running, cycling–and you must be consistent. Three times a week will help your heart, but it might not be enough to promote sleep. Twenty to thirty minutes, five days a week is a good target to shoot for.
Nix the nightcap. Many people like to have a nightcap to put them to sleep–29 percent of those reporting sleep difficulties in a national survey use alcohol to help them sleep. While alcohol may induce sleep. While alcohol may induce sleep, at the same time it lowers the quality of your sleep and leaves you prone to waking up during the night. And drinking to induce sleep can lead to dependency.
Forget the smokes. Nicotine is a stimulant. It raises blood pressure, gets the heart going faster and makes your brain more active. If you’re a heavy smoker, nicotine withdrawal during the night may awaken you.
Feel drained. If you often find yourself waking up to urinate at night, try walking around the house or doing some other mild activity for 5 or 10 minutes an hour or so before you turn in. This helps circulate fluids into your kidneys, stimulating you to visit the bathroom before retiring. You should also avoid drinking liquids two hours before retiring.
Go for peace and quiet. If you’re easily distracted during the day, you might be easily distracted at night, too. Besides wearing earplugs, you might try turning on a fan to mask distracting noises, or try listening to a tape of a waterfall, waves or rain.
Calibrate the room temp. A room that’s too cold or too hot can awaken you. Make sure before you retire the room temperature is comfy.
Tame your tummy. Avoid heavy, spicy foods at night. They might increase your production of stomach acids and give you indigestion and awaken you.
PATTERN #3: TOO EARLY ASLEEP, TOO EARLY AWAKE
Get the light treatment. Many persons have no trouble falling alseep or sleeping soundly through the night. Their sleep appears normal. But they cannot remain awake beyond the early evening hours and they cannot
manage to sleep until sunrise.
They’re suffering from advanced sleep phase syndrome (ASPS), which is essentially the opposite of delayed sleep phase syndrome. Whereas the latter is prevalent in young persons, advanced sleep phase disorder becomes more common with age.
Once again, a light box offers a solution: “One or two hours of bright light, to end about one hour before the desired sleep time, is best,” says Dr. Lewy. “Try this for two weeks. Shift the light-exposure time gradually later (15 minutes a day until you reach the desired time), say from 7-9 p.m. to 8-10 p.m. Gradually decrease the daily exposure to 30 to 60 minutes.”
Not all persons experience early awakenings have ASPS. “Depression can also cause early-morning awakenings,” says Dr. Walsh.
